Ob-Gyn Coding Alert

Question: If a patient transfers out prior to delivery, how should I bill for all visits to date? Should I use a diagnosis other than pregnancy?

California subscriber

Answer: For your CPT® code, you'll have to count the number of visits the ob-gyn saw the patient to determine the correct code. Under CPT® rules, if the ob-gyn saw her only one, two or three times, you bill each as an E/M code (99201- 99205 for new patients, 99211-99215 for established patients).

If the ob-gyn saw her four to six times, you bill 59425 (Antepartum care only; 4-6 visits) instead. If the ob-gyn saw her seven or more times before the transfer, you should bill 59426 (... 7 or more visits) instead. But look at what the payer wants because its guidelines may be different from CPT® rules.

You use the diagnosis that represents each E/M visit (pregnancy or pregnancy complication), and if billing the series of antepartum visits, add the codes that describe any complications. If none, then use just V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).

ICD-10: When your diagnosis code system changes, you'll have new options for those codes mentioned in this article:

Code V22.0 expands into four options: Z34.00 (Encounter for supervision of normal first pregnancy, unspecified trimester), Z34.01 (... first trimester), Z34.02 (... second trimester), Z34.04 (... third trimester).

Code V22.1 will include the four new codes listed above as well as four more: Z34.80 (Encounter for supervision of other normal pregnancy, unspecified trimester), Z34.81 (... first trimester), Z34.82 (... second trimester), and Z34.83 (... third trimester).